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Implants can be used to treat impotence when other options have not worked or are not suitable. Erectile dysfunction is caused by vascular insufficiency secondary to diseases like athelerosclerosis, diabetes mellitus and cigarette smoking; neurogenic problems like spinal cord injury; surgery or radiation. It can also be caused by liver disease related to excessive alcohol intake. Though penile implant is most suited for a man with organic impotence, a man with psychogenic impotence can also benefit, if he has not had success with sex therapy. Sometimes a penile prosthesis is implanted during surgery to reconstruct the penis when scarring has caused erections to curve (Peyronie's disease).
A penile prosthesis does not change sensation on the skin of the penis or a man's ability to reach orgasm. Ejaculation is not affected. Satisfaction rates with the prosthesis are very high, and typically 80%-90% of men are satisfied with the results and can have satisfactory intercourse.
Types of Implants
Semi-rigid or Malleable implants are the simplest and consist of a pair of silicone rods. They are stiff enough to allow penetration but are bendable. They may contain a steel cable or coiled wire running through the center of each rod.
These implants are simple and easy to use without complicated parts, which also makes them less expensive. To initiate intercourse the penis is lifted into position, i.e the rods are straightened. As the penis is semi erect all the time, it may be more visible and needs to be concealed under tight underclothing. With these implants the length and width of the penis cannot be increased, as it happens in physiological erection. In spite of their limitations, these implants are much sought after, because of their simplicity and affordability.
Inflatable (hydraulic) implants are slightly more complicated and consist of two hollow cylinders made of silicone or polyurethrane that come as a one-, two-, or three-piece unit. The one-piece device has a pump at one end and a reservoir at the other. The entire device is placed in the penis. To get an erection, you pump the front of the cylinder, allowing saline solution to move out of the reservoir into the hollow rods. This inflates and straightens the rods, thereby creating an erection. At the end of intercourse you can deflate the device by bending the penis down for a few moments, causing the fluid to return to the reservoir.
In the two-piece implant, a pump and reservoir are placed in the scrotum. With the three-piece device, only the pump is inserted in the scrotum; the reservoir is placed in the abdomen.
The advantage of the inflatable implants is that they more closely mimic natural erection. The man has the control over when and for how long the erection happens. There may be some enhancement of width and length of the penis too. When deflated, the penis is softer and more natural. These inflatable implants are suitable for more committed individuals who want a more natural erection.
The decision about going in for implant surgery and the type of implant to use has to be made after detailed discussion with your surgeon. You need to weigh the pros and cons of each intervention. The surgery is performed under general or spinal anaesthesia. The procedure takes about 1-2 hours and you may need to stay in hospital for abort 24 hours after surgery.
A small cut may be made between the penis and scrotum. After deciding on the appropriate implant size, the doctor places the implant components in the two chambers (corpora cavernosa) in the penile shaft that would normally fill with blood during an erection. That's the end of the surgery, unless the implant requires the additional placement of a reservoir and pump. . The penis is usually taped to the abdomen until the incision heals and a tube or catheter will be inserted to drain the bladder.
You can expect to resume your normal everyday activities over the course of 2-4 weeks, though some men return to work a few days. You should avoid strenuous physical activity including intercourse for 4-6 weeks after surgery till the area has healed well. Normal sexual activity may be allowed after 6-8 weeks.
Even though it involves surgery, for most men who have been thoroughly investigated and unsuccessfully treated with all other available options , implants are their final hope and mean a renewed confidence in their ability to perform.